11. West Oakland
Program
•Assesses client for admission to
program
•Check Medi-Cal status
•Complete the Placement
Authorization (PA) Form and Day Treatment
Authorization Criteria form and turn into Chief of Outpatient Services
for
signature
Chief of Outpatient Services
•Signs PA Form and distributes to
Program, PST and QA offices
Program
•Chart goes to CQRT for continued
Authorization
Ø Every
90 days for Intensive Day Tx.
Ø Every
180 days for Rehabilitative Day Tx.
Forms to use:
•PLACEMENT AUTHORIZATION
FORM
•DAY TREATMENT AUTHORIZATION
CRITERIA FORM